Healthcare Provider Details

I. General information

NPI: 1760856777
Provider Name (Legal Business Name): JUSTIN DANIEL MACCARO D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FRANKLIN AVE
GARDEN CITY NY
11530
US

IV. Provider business mailing address

910 FRANKLIN AVE
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-742-9050
  • Fax:
Mailing address:
  • Phone: 516-742-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number058280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: